mbbs undergraduate rural clinical program 2011 · 1. purpose..... 4
TRANSCRIPT
MBBS Undergraduate
Rural Clinical Program
2011
Year 5 Guidelines
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C O N T E N T S
1. PURPOSE ......................................................................................................................................................... 4
2. ABOUT THE UTAS RURAL CLINICAL SCHOOL .................................................................................................... 4
2.1 Introduction .................................................................................................................................................. 4
2.2 Rural Medicine Learning Outcomes ............................................................................................................. 4
3. STAFF CONTACTS FOR UNDERGRADUATE PROGRAM ...................................................................................... 5
4. THE YEAR 5 PROGRAM .................................................................................................................................... 7
4.1 Overview of the Program ............................................................................................................................. 7
4.2 Critical Skills and Experiences ...................................................................................................................... 7
4.4 Group Learning Weeks ................................................................................................................................. 8
4.5 RCS Clinical Attachments .............................................................................................................................. 9
5. ASSESSMENT .................................................................................................................................................. 11
5.1 Attendance ................................................................................................................................................. 11
5.2 Learning Portfolios ..................................................................................................................................... 11
5.3 Portfolio Assessment Process .................................................................................................................... 11
5.3.1 Due Dates .................................................................................................................................................... 11
5.3.2 Submitting Work ......................................................................................................................................... 13
5.3.3 Meeting with Clinical Academic Mentor and Collecting Marked Assessments ....................................... 13
5.4 Assessment Requirements ......................................................................................................................... 13
5.4.1 Marking Guides ........................................................................................................................................... 13
5.5 RCS Formative Assessment Requirements ................................................................................................ 13
5.5.1 Clinical Log Book ......................................................................................................................................... 13
5.5.2 Complex Rural Longitudinal Case ............................................................................................................... 14
5.5.3 Elective reports ........................................................................................................................................... 15
5.5.4 Penalties...................................................................................................................................................... 15
6. REMEDIATION ................................................................................................................................................ 15
7. LEARNING RESOURCES ................................................................................................................................... 15
7.1 Suggested Reading...................................................................................................................................... 15
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7.2 Library and Information Technology Support ........................................................................................... 16
7.3 Clinical Skills and Simulation Centre .......................................................................................................... 16
8. STUDENT SUPPORT ........................................................................................................................................ 16
8.1 Mentors ....................................................................................................................................................... 16
8.2 Vertical/Horizontal Integration in the Year 4 & 5 RCS Medical Undergraduate Program ....................... 17
8.2.1 Year 4 Peer Support .................................................................................................................................... 17
8.2.2 Final Year Peer Support Program ............................................................................................................... 17
8.2.3 Horizontal Integration ................................................................................................................................ 17
8.3 Additional Educational Support ................................................................................................................. 18
8.4 Communications ......................................................................................................................................... 18
8.5.1 RCS Staff ...................................................................................................................................................... 18
8.5.2 Personal GP Services .................................................................................................................................. 19
8.5.3 Medical/Counselling Services .................................................................................................................... 19
9. APPENDICES ................................................................................................................................................... 19
9.1 Guidelines for Writing Case Histories and Sample Marking Sheets ......................................................... 19
9.2 Complex Rural Longitudinal Case History Assessment Form .................................................................... 20
9.3 Clinical Log Book example .......................................................................................................................... 21
9.4 Clinical Log Book example – Example of Satisfactorily completed Log Book ........................................... 23
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1. PURPOSE The Rural Clinical School guidelines are designed to be a practical resource that: • Clearly outlines the learning and assessment requirements for students undertaking Year 5 of the five year
MBBS course through the Rural Clinical School (RCS).
• Provides information on the resources available to medical students at the RCS. Students should use this document in conjunction with the Year 5 School of Medicine (SoM) Handbook, Unit Outline and the document “Learning Objectives for Years 4 & 5 Clinical Attachments 2011” to ascertain all their learning and assessment requirements for Year 5 medicine.
2. ABOUT THE UTAS RURAL CLINICAL SCHOOL
2.1 Introduction
The UTAS Rural Clinical School has a charter to provide a rural and remote health context for learning to ensure that students have competencies and attributes that will equip them to practice in rural and remote settings.
The University of Tasmania’s Rural Clinical School:
• Is part of a national rural education and training network funded through the Australian
Government’s Department of Health and Ageing – Regional Health Strategy. • Focuses on preparing medical and other health profession students for rural practice. • Provides students with clinical education and training, and supports health practitioners in rural and
remote areas. • Delivers clinical education, training and experience through the North West Regional Hospital
(NWRH) Burnie, the Mersey Community Hospital Latrobe, the North West Private Hospital (NWPH) Burnie, and a network of general practices, district hospitals and community health facilities.
• Is one of three medical clinical schools in Tasmania (Hobart, Launceston and the North West region).
2.2 Rural Medicine Learning Outcomes
In addition to the generic themes and principal outcome measures outlined in the SoM Handbook, the following rural medicine learning outcomes will be achieved. Students will (through clinical skills and verbally or in writing) demonstrate an understanding of the following:
1. Socio‐demographic and cultural differences between rural and city life, and their effect on
professional/patient/community relationships. 2. Aboriginal health care issues in a regional context. 3. Conduct of referrals, and the relationships between the referring rural GP and their city and/or
provincial specialist. 4. Impact of isolation on patient and family behaviour in addressing health problems. 5. Impact of geographic isolation of patients on medical management.
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6. Impact of professional isolation on medical practice and on the personal lives of medical and other health professionals.
7. Inter‐relationship between rural and urban health care providers and facilities. 8. Development and operation of a health care team. 9. Medical evacuation of the injured or ill patient. 10. Potential of telehealth developments for rural health care delivery. 11. Techniques for maintaining professional competence and standards for professionals outside of
tertiary clinical environments. 12. Knowledge of the social services in the community in which they are working.
3. STAFF CONTACTS FOR UNDERGRADUATE PROGRAM Acting Co‐Heads of School Assoc Prof. Peter Arvier & Dr Lizzi Shires Personal Assistant Ms Jennifer Beamish
Year 4 & 5 Rural Medical Undergraduate Program (Personnel/roles may change through the year to allow for leave)
RCS Academic Staff Associate Professor Peter Arvier (Associate Professor Rural Medicine)
Overall Program Co‐ordinator, clinical attachments, CBL, tutorial program and student assessments
Dr Lizzi Shires (Associate Head Community Medical Education)
Co‐ordinator and program development for community based medical education
Dr Robyn Brogan (Clinical Senior Lecturer)
CBL, Palliative care and complex chronic illness clinical attachments, mentoring, professional skills teaching
Dr Alan Rouse (Clinical Senior Lecturer)
CBL, tutorial program, assessment, mentoring, therapeutics teaching
Ms Rose Moore (Medical Education Advisor)
Educational support
Dr Satish Kumar (Clinical Senior Lecturer ‐ GP)
GP liaison, tutorial program, CBL, assessment, mentoring
Dr Bryn Parry (Clinical Senior Lecturer ‐ GP)
GP liaison, tutorial program, CBL, assessment, mentoring
Dr Bert Shugg (Clinical Senior Lecturer Paediatrics)
Paediatric teaching and clinical attachments, CBL, tutorial program
Dr Nick Towle (Clinical Lecturer and Medical Education Advisor)
CBL, tutorial program, assessment, mentoring, educational support in clinical skills and simulation
Dr Michael Buist (Clinical Senior Lecturer ‐ Medicine)
General medical clinical attachments, CBL, tutorial program, mentoring
Dr Tom McDonagh (Clinical Senior Lecturer ‐ Emergency Medicine)
Emergency Medicine clinical attachments, tutorial program, mentoring
Dr Deb Wilson (Clinical Senior Lecturer ‐ Anaesthetics)
Anaesthetic clinical attachments, Tutorial Program, assessments, mentoring
Dr James Roberts‐Thompson (Clinical Senior Lecturer – General Surgery)
Surgical clinical attachments Mersey Hospital, CBL, tutorial programs
Community Support Ms Therese Evans (Acting Mgr Marketing and Community Engagement)
Support for MBBS students in the community
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RCS Clinical Skills and Simulation Centre Ms Lynn Greives (Clinical Skills Educator)
Clinical Skills Education
Ms Luanne Steven (Clinical Medical Educator)
Clinical Skills Education
RCS Administrative Support Staff Dr Sharon Condon (Executive Officer (Academic) and Student Liaison Officer) Mrs Kylie Bennett (Administration Officer – Hospitals Program ‐ Year 4 & 5 Clinical Placement and Tutorial Program) Mrs Maggie Lea (Administration Officer –Year 4 Primary Care Program and Year 5 Remote Attachments) Ms Veronica Moore (Senior Administration Officer (SAO) & Facilities Officer) Ms Claire Grist (Administration Officer – Accommodation and ACRRM) Ms Issy Neal (Administration Officer – Finance) Ms Louise Lee (Administration Assistant – Reception) Mrs Renee Harvey (Administration Assistant – Support) Mr Clinton Weber (ICT Officer) Acute Services Attachment Co‐ordination Dr Michael Buist Medical ward teaching and tutorials Dr Tom McDonagh Emergency medicine teaching and tutorials Dr Bert Shugg Ms Jeanette Hermans
Women’s and Children’s Health ward teaching and tutorials
Mr Russell Furzer (NWRH – Orthopaedics) Dr Ferraby Ling (Orthopaedics) Mr Trevor Leese (NWRH – General Surgery) Dr James Roberts‐Thompson (MCH)
Surgical ward teaching and tutorials
Dr Deb Wilson Anaesthetics / ICU Dr Robyn Brogan Palliative Care Dr Ali Maginness Mental Health attachment and tutorials
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4. THE YEAR 5 PROGRAM
4.1 Overview of the Program
The educational program that final year medical students will experience in 2011 at the RCS consists of:
Clinical attachments in:
• Rural/Remote Medical Practice • General Surgery • General Medicine • Emergency Medicine • Anaesthetics/ICU • Complex Chronic Illness/Palliative Care • A selective – to be negotiated with the RCS Associate Head. • Group Learning Weeks incorporating case based learning, tutorials, skills sessions and reflective
practice.
At all times, students are expected to wear their medical student identification, dress and conduct themselves in a professional manner (please refer to the SoM Handbook). Students are reminded that all procedures on patients can only be performed under the direct supervision of relevant nursing or medical staff.
4.2 Critical Skills and Experiences
In designing the final year medical program, careful consideration has been given to the critical skills and experiences required for a medical graduate to act safely and capably as an intern. Final year medical students will be expected to: • Manage a proportion of patient intakes to their unit, taking an appropriate history, performing
examinations, suggesting a plan of investigation and recommending treatment. This information should then be presented to a supervisor who will provide suitable feedback.
• Perform basic ward procedures including ordering pathology and other relevant investigations and writing discharge summaries, all of which need to be countersigned by a registered medical practitioner.
• Be familiar with appropriate procedures for writing drug charts and prescriptions. • Know the legal and ethical aspects involved in gaining patient consent for a procedure. These issues will
be dealt with specifically in the teaching program. • Attend for at least 80% of their clinical attachment unless specific exemption has been granted by the
Associate Head Rural Clinical School. • Participate in all activities of the clinical unit to which the student is attached. This may include
presenting cases on ward rounds and during unit meetings. • Respond to opportunities during the day, but also after hours, when rostered on‐call or the medical staff
of the unit suggests there is an opportunity to gain a particular clinical experience or perform or further practice a procedural skill.
• Longitudinally follow patients they have met in their clinical attachment, preferably extending beyond their hospital or GP encounter into other community services and into the patients’ homes.
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4.3 Support
To assist in achieving these expectations, final year medical students will receive:
• Structured tutorials, practical procedural skills instruction, CBL sessions and opportunities to reflect on professional practice.
• Opportunities for self directed learning around patients. • Support from the team based in the Clinical Attachment site. • Full support and direction from the RCS academic team including regular meetings with your mentor.
4.4 Group Learning Weeks
The last week of each six week attachment will be a Group Learning Week, during which concentrated teaching will occur through case based learning, tutorials, skills centre sessions and reflective practice sessions. These weeks will be organised around a theme, covering three or four of the essential CBL topics. The first five weeks of each attachment are uninterrupted attachment time, except for some lunchtime JMO tutorials and Health Forums. The aim of this program is to produce competent, capable and effective interns. Group Learning Week Example Format (flexible structure)
Year 5 – Group Learning Week 1 ‐ **EXAMPLE ONLY**
Monday 8th Tuesday 9th Wednesday 10th Thursday 11th Friday 12th
Public Holiday
0900‐1030 CBL Complex Respiratory Presenter tbc Dr Peter Arvier Students: 1045‐1145 Intern Skills: Pathology: ordering and interpretation (Part 1) Dr Peter Arvier Pathology presenter tbc
0900‐1030 CBL Pre‐operative Assessment Dr Deb Wilson Dr Nick Towle Students: 1030‐1230 Clinical Scenario Team work, management 4 teams Dr Nick Towle Dr Deb Wilson Lynn Grieves Luanne Steven
0900‐1000 Palliative Care Tutorial Introduction to Pain Management in Palliative Care Dr Robyn Brogan 1015‐1230 CBL Wholistic approach to pain management Dr Robyn Brogan Dr Bryn Parry Students:
0900‐1030 CBL Complex Cardiac Dr Peter Arvier Students: 1045‐1145 DEM Tutorial ECG Interpretation Dr Peter Arvier Or Dr Tom McDonagh 1200‐1330 OSCE/Portfolio Practice
1230‐1330 JMO Tutorial Oxygen Therapy Dr Mark Reeves Dr Mike Buist
1230 ‐1330 Health Forum Grand Round: O&G Dr Tania Hingston
1230 ‐1330 JMO Tutorial (Skills) BLS Practice
1330‐1530 Procedural Skills (Pre‐op and BLS and Accred) Dr Nick Towle Dr Deb Wilson Lynn Grieves Luanne Steven
1330‐1430 Intern Skills Writing up drug charts, IV fluids, hospital notes (Part 1) Dr Nick Towle
1400‐1500 Therapeutics Pain management: Complex therapeutics Dr John Henshaw GLW Evaluation and Feedback
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4.5 RCS Clinical Attachments
Remote Medical Practice Remote attachments are located in the communities of Smithton, King Island and West Coast (Queenstown/Strahan). Students will have an attachment of five weeks at one location. Students are required to liaise with the Remote GP Administration Officer (Maggie Lea – 6430 5903) prior to commencing this attachment. Students who wish to undertake remote attachments at other locations must discuss this with the Associate Head. An accommodation kit is available for collection and students are expected to make personal contact with the GP to confirm their attendance at least a week prior to taking up their attachment. To appreciate the particular challenges and limitations of medical care in remote communities, it is strongly recommended that students remain in their community for the full duration of the attachment. A clinical log book should be completed and is available on MyLO for downloading, an electronic version is also available this year. Students are required to complete and present a Complex Longitudinal Rural Case during the year as part of the formative assessments. A remote attachment is often the best opportunity to source such a case. (See also 5.5.2) General Surgery Students will be rotated through different general surgical teams or orthopaedic teams to maximise learning opportunities. Please note that orthopaedics is now included as a surgical term in final year as it is also a recognised core term for the intern year. There will be a mixture of theatre, ward work and clinics. Individual student programs will be developed with participating students in the week prior to the commencement of the attachment. Mr Trevor Leese will co‐ordinate the medical student program in general surgery for 2011 and Mr Russell Furzer in orthopaedics A clinical log book should be completed and is available on MyLO for downloading. General Medicine Students will be assigned to a Registrar and Consultant during the medical attachment and undertake a range of tasks including ward work, clinics, Unit education program and focused student bed‐side teaching and case discussions. Dr Michael Buist will coordinate the student attachment program. Students will be allocated to either Mersey Hospital or NWRH. A detailed attachment timetable is available on MyLO. A clinical log book should be completed and is available on MyLO for downloading.
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Emergency Medicine Students are requested to download a copy of the DEM Guidelines and the Super Suturing documents from MyLO prior to commencement of the attachment. Dr Tom McDonagh coordinates the student attachments. Students participate in all activities of the unit including the Wednesday morning DEM teaching program. This includes the 0730 student case presentations. All students are expected to bring along a brief case with which they have personally been involved in the preceding week. These case presentations will count towards the overall assessment for the attachment. A roster for each attachment is also available on MyLO. Students are expected to be available for morning, evening, night and weekend shifts. A clinical log book should be completed and is available on MyLO for downloading. Anaesthetics/ICU During your three week period of introduction to Anaesthesia and Intensive Care you will be attending a wide range of departmental activities ranging from ward rounds to attending elective and emergency lists in theatre. Your primary point of reference for any queries/help is the Departmental Supervisor of Training and Clinical Senior Lecturer, Dr Deb Wilson or Dr Alan Rouse. Students are required to report to ICU at 0800 on the Monday of their first week of the attachment for briefing. A Medical Student Logbook & Orientation Manual should be completed and is available on MyLO for downloading. Complex Chronic Illness/Palliative Care Students are expected to undertake an orientation with Dr Robyn Brogan prior to commencement of the attachment and to meet with Dr Brogan at intervals during the attachment. An Acute Chronic Disease Workbook and an Acute Chronic Disease Handbook are available on MyLO for downloading. Selective Selectives MUST be approved by the Associate Head of the Rural Clinical School before any arrangements (including travel) are finalised (see forms in SoM Year 5 Handbook, available on MyLO). Students are strongly encouraged to discuss their selective plans with their mentor for guidance on suitable selective clinical attachments. Financial support from the RCS may be available for students undertaking selective attachments with a substantial exposure to indigenous health. Further information on this is available on MyLO or by contacting the Associate Head.
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Students are expected to make contact with the nominated clinical supervisor prior to taking up their selective. Selective reports must be completed (see SoM Year 5 Handbook)
5. ASSESSMENT Summative assessment requires the satisfactory completion of all formative and summative components, both those common to all three clinical schools (see SoM Handbook) and those specific to the RCS. This includes submitting a complete and satisfactory portfolio over years 4 & 5 and obtaining a pass in the written and practical (OSCE) examinations (further information available in the SoM Handbook).
5.1 Attendance
As outlined in the SoM Handbook, students must attend a minimum of 80% of scheduled teaching and learning sessions. To ensure that minimum standards are met for successful completion of the year, students are required to sign the attendance register (when provided) for tutorials and other group sessions. Students must apply on the appropriate form available from the RCS office for absences due to illness/other reason, either before, or as soon after the event as possible. Supporting evidence, eg medical certificates may be required. Students are reminded that satisfactory Clinical Attachment reports need to be provided and these will be affected by attendance and involvement on the wards. At all times, students are expected to wear their medical student identification, dress and conduct themselves in a manner that reflects the ethical standards of the profession and the expectations of colleagues and patients. Failure to meet these expectations is likely to result in poor assessment reports from clinical supervisors and academic staff. This may adversely affect achieving a pass result for the year. 5.2 Learning Portfolios
Students will continue to collect assessed work for their Portfolio , adding to that which has been completed in Year 4. The summative components common to all clinical schools are outlined in the Year 5 Handbook. Additional formative assessment differs between clinical schools and, for the RCS, is deailed below. Please consult the SoM Year 5 Handbook for the details of the summative components (word counts, topics etc).
5.3 Portfolio Assessment Process
5.3.1 Due Dates
In the last week of each clinical attachment, students will present their assessment pieces (in your grey plastic satchel) to reception. At the end of the following Group Learning Week there will be an opportunity for mentor meetings to discuss assessment and other aspects of your program. Generally formal meetings with mentors will occur three times per year, although students are free to access mentors at any time by making an appointment.
During attachment 6, outstanding assessment pieces will be due by 4.30 pm on Monday 3rd October, with the exception of your final clinical attachment report and log books, which are due by 4.30 pm on Friday 28th October.Your complete Learning Portfolio is due for submission (with the exception of your final clinical attachment report and log books as detailed above) via reception by 4.30 pm on Friday 7th October.
The timing for submission of the different components is as follows:
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Summary of RCS Portfolio Assessment Requirements and Timelines
Assessment Task Due Date Summative / Formative
Due Date
Clinical Attachment Reports (11 including 1 x rural/remote, 1 x selective and 1 x elective)
End of each attachment/placement.Mid attachment report must be completed and will include log book review. Final report from clinical supervisor AND a registrar in DEM, Medicine and Surgery.
Summative
11th March, 201121st April, 2011 10th June, 2011 29th July, 2011
9th September, 2011 28th October, 2011
Elective Report In first GLW in the form of a poster presentation for peer review.
7th March, 2011
Reflective Pieces (1 or more)
Final submission by the end of attachment 5 (if more than one piece, can be submitted earlier)
Summative 9th September, 2011
Core Competencies – (Venepuncture, IV Cannulation, CPR, Male & Female Urinary Catheterisation)
100% of skills completed by the end of the year.
OSLERs (3)
One to be completed by the end of attachments 3, 4 and 5.
Summative 10th June, 201129th July, 2011
9th September, 2011
Long Case Histories (2)
One to be presented at completion of clinical attachment 3 and 5. Must be from different disciplines Once Chronic Disease Case including Complex Therapeutics and one Acute Illness Case (need Head of School approval if other than SoM specified disciplines)
Summative 10th June, 2011
9th September, 2011
Complex Rural Longitudinal Case presentation (use one of the Long Case Histories)
By the end of attachment 5.Oral presentation to peer group in Group Learning Week. Hard copy to be put in your portfolio.
Formative 9th September, 2011
Evidence of active involvement in Education and Related Activities (100 points for the year)
*To be accrued continuously throughout the year to a total of 100 points. (See SoM Handbook for points allocation) Progressive review throughout the year.
Formative
CBL Tasks Throughout the year – at least one. Formative
Log of Skills Form
A new form to be completed and submitted at the end of each attachment. A form detailing collated totals your final two years should be submitted at the end of attachment 6. 100% of skills to be completed over years 4 and 5. Please note the SoM requirements for competencies requiring “sign off”.
11th March, 2011 21st April, 2011 10th June, 2011 29th July, 2011
9th September, 2011 28th October, 2011
Clinical Log Book
To be submitted at the end of each attachment. Cases where you have had “significant involvement” only. Average at least one case per day. Include procedural skills, discharge summaries, death certificates, drug charts, referral letters etc.
11th March, 2011 21st April, 2011 10th June, 2011 29th July, 2011
9th September, 2011 28th October, 2011
*Students should consult with their clinical supervisors and mentors to determine opportunities for gaining these points in their clinical and academic program. If students would like to gain research points, contact Dr Mark Reeves about involvement in research activities (eg Pharmacy audits).
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5.3.2 Submitting Work
Each assessment task must have an Assignment Cover Sheet and the relevant marking sheet (available on MyLO), and have all relevant sections completed by the student. At the completion of each attachment all required assessments should be placed in the Portfolio Assessment Satchel and logged in with reception staff. 5.3.3 Meeting with Clinical Academic Mentor and Collecting Marked Assessments
It is the student’s responsibility to attend appointments with their mentor to discuss their portfolio and progress through the course and collect their assessed work (see 8.1). Please note that, to ensure consistency within and across clinical schools, case histories may be assessed by clinical academics other than your own mentor, including assessors from other clinical schools. These assignments will be de‐identified if being seen by an assessor from another clinical school. Generally speaking, mentors will assess reflective practice pieces.
5.4 Assessment Requirements
5.4.1 Marking Guides
Marking Guides for all assessment tasks can be found on MyLO. Marking sheets for assignments common to all clinical schools are also found in the SoM Handbook; those for RCS specific formative assessment tasks are included below under the respective tasks. These should be used to guide students in the content of the assignment and the standard of performance that is required to gain a satisfactory pass. Assessors will also use these Guides to grade assessment tasks.
Please note that the Portfolio Assessment (which includes Formative Assessment) becomes summative at the end of the academic year. All formative assessments must be satisfactorily completed to be able to sit the summative assessment.
5.5 RCS Formative Assessment Requirements
5.5.1 Clinical Log Book
Each attachment (including Rural/Remote Practice) has a specific clinical log book that students will be expected to maintain for the duration of the attachment. Clinical supervisors will review progress of the log book during the attachment (most likely at about the half way mark) and will discuss with the student and sign off at the end of the attachment. For shorter attachments, the clinical supervisor may only need to discuss with the student at the end of the attachment although more frequent review may be requested by supervisor or student. The log book is to record details of cases with which students have had substantial personal involvement. The log books will summarise such information as:
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• Principal clinical problem/diagnosis • Procedures performed or observed by the student; (linked to those skills set out in the SoM
Handbook); • Forms, discharge letters, other correspondence completed by the student; • Learning Opportunities/points for discussion/revision topics/case presentation or other
research that arose as a result of that patient encounter; • Any other involvement such as discharge visits to the patients GP, attendance with the
patient at allied health or medical specialist consultations, case conferences etc.
Each discipline will have its own log book but the basic structure will be similar across the disciplines. A generic example is provided in the appendix. The front page of the log book lists those procedural and other skills relevant to the attachment, and also a summary of the Learning Objectives from the SoM Handbook. This is a guide for students and supervisors alike. Students are encouraged to carry their logbooks with them at all times on a clinical attachment to record information “on the go” and these can be used as an aide memoire when presenting cases on ward rounds and recording tasks undertaken. As a general guide, students should aim to record at least one significant case per day from their clinical attachment.
At the completion of the attachment the student will be expected to summarise the procedures and tasks completed during the attachment. The supervisor’s clinical attachment assessment report will be appended to the log book. Students should obtain reports from more than one supervisor for the attachments in Surgery, Medicine and Emergency Medicine. These could be from a consultant or registrar with whom the student has worked closely. This will give a more complete picture of the student’s readiness for their intern year. These reports are to be appended to the clinical log book. GP Learning Topics There is a list of GP Learning Topics on MyLO that can be used by GPs and students as a guide to the scope of teaching and learning relevant to rural/remote medical practice. 5.5.2 Complex Rural Longitudinal Case
This component of the formative assessment does not need to be a separate case, but can be applied to one of the 3 long case histories required for summative assessment (see Year 5 SoM Handbook). The case which includes these Complex Rural Longitudinal emphases should contain a maximum of 3,500 words (the remaining 2 cases are required to be no more than 3,000 words long). Please include a word count in the submission. The report should include supporting references listed according to the Vancouver method. This patient should be selected from those seen during clinical attachments (or in remote practice if there is the opportunity to follow them longitudinally eg., into the hospital) and the illness/problem should be chronic in nature. Supervising clinicians can provide guidance in the selection of a suitable case. Follow up should include home visits, attendance at community based specialists/allied health providers, hospital admissions/visits and GP appointments as appropriate. The case therefore needs to be relatively complex, however the details of the case itself should be concisely stated. In addition to fulfilling the requirements for the ‘basic’ Long Case History as outlined in the SoM Handbook, there must be a focus on aspects of management that illustrate the particular constraints, psychological stressors and financial and other challenges experienced by patients in rural settings, as well as team care management, communication between rural and urban health
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professionals and the availability of appropriate services in the patient’s community. (Refer to section 2.2 for learning outcomes to direct your presentation). The assessment form for the Complex Rural Longitudinal Case will be the same as that in the SoM Handbook for the case you have chosen to further develop as the CRLC. As part of the assessment, students will be expected to present these cases to an audience of students and RCS academics as part of Group Learning Weeks, therefore preparation of suitable cases must commence early and not be left until the last GLW. While the summative long cases, require a formal written case history for the portfolio, a copy of the CRLC Powerpoint presentation will be sufficient for the portfolio. 5.5.3 Elective reports
All students are expected to present a report of the elective undertaken during the preceding summer break. For 2011, these presentations will be in the form of a poster presentation in the first GLW and a brief oral presentation to the year group and RCS staff. The posters will remain on display to a wider audience of students, RCS academic staff and hospital staff. A suitable template for a 1mx1m poster can be found at www.posterpresentations.com 5.5.4 Penalties
Please consult the School of Medicine Year 5 Handbook regarding penalties which will apply for late or unsatisfactory work. Applications for extensions must be submitted on the appropriate form prior to the due date.
6. REMEDIATION If assessments are not completed to a satisfactory standard, the assessor, supervisor or mentor in conjunction with the RCS Associate Head will discuss resubmission or a remediation plan with the student. This may involve remediation occurring during a selective term or during University vacation. Students are strongly advised to not make unchangeable plans for vacations (or at least ensure adequate insurance cover) in the event that remediation time or supplementary examinations are required.
7. LEARNING RESOURCES
7.1 Suggested Reading
See the Year 5 School of Medicine Handbook for specific texts, journals and websites.
Also note that Evidence Based Medicine requires constant reference to the latest research and peer reviewed journals to keep abreast of current trends. UpToDate and Therapeutic Guidelines are available online through the RCS. Details are available during orientation. The Australian College of Rural and Remote Medicine (ACRRM) provides 22 curriculum statements which reflect the spectrum of common patient presentations in rural areas and defines the knowledge and skills required to deal with the clinical realities of rural and remote medical practice.
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Medical students can access the ACRRM curriculum statements by:
• Visiting RRMEO at http://www.acrrm.org.au • Borrowing a copy of the CD ROM (see the Administration Officer – Hospitals Program), or • Requesting a print copy from the Medical Education Advisor.
7.2 Library and Information Technology Support
An excellent clinical library is located at the North West Regional Hospital. Students have access to additional library support through the hospital library’s links to the statewide University library network, to the Hobart Clinical School Library’s email reference service, to a web based electronic textbook service, and to the resources offered by the worldwide web. Approximately 2.5 kilometres from the hospital is the University’s Cradle Coast campus, which offers an additional access point into web based services. The University and the Department of Health and Human Services have statewide videoconference networks, and both the North West Regional Hospital and the University’s Rural Clinical School are linked into these networks. Students have direct access to the University library through the RCS computer facilities. 7.3 Clinical Skills and Simulation Centre
The RCS has a well equipped Clinical Skills and Simulation Centre with trained and dedicated staff, where students learn and practice procedural and other practical and professional skills, including videotaping to improve consultation skills. This may be in a multi‐disciplinary learning environment with nurses, paramedics or other health professionals. The Centre provides an excellent opportunity to learn the essentials of and practice these skills before performing them on a patient. Students wishing to obtain additional practice in clinical skills outside scheduled sessions must contact Ms Lynn Greives or Ms Luanne Steven to make suitable arrangements. The simulated environment complements, but does not substitute for the clinical environment. Students are strongly encouraged to take full advantage of the vast amount of clinical opportunities available in the hospital and general practice settings. During 2011, a new clinical skills and simulation centre will be developed at the Mersey Hospital.
8. STUDENT SUPPORT 8.1 Mentors
Each student will be allocated a mentor from the academic staff of the RCS. On several occasions during the year an appointment will be made for the student to meet individually with their mentor to review assessed work, discuss learning objectives for attachments and give assistance or advice in regard to any personal, professional, educational or other matter which may be impacting on the student’s progress through their medical training. Other staff are also available for mentoring if required. In particular Dr Robyn Brogan may be available to assist students having difficulties with professional issues such as the doctor‐patient relationship, breaking bad news, dealing with grief etc.
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Dr Sharon Condon (Executive Officer – Academic) is also available to students as the Student Liaison Officer for issues that students feel they are unable to take to their usual mentors or clinical supervisors or have been unable to resolve through the usual channels. 8.2 Vertical/Horizontal Integration in the Year 4 & 5 RCS Medical Undergraduate Program
8.2.1 Year 4 Peer Support
The RCS is committed to a program where vertical integration is an important aspect of the learning environment. Year 4 and Year 5 students learn together during Health Education Forums and on the wards, Year 5 students provide peer support to Year 4 students. In turn, when Year 1, 2 and 3 students visit the campus on short attachments, Year 4 students provide peer support. Part of the Year 4 Peer Support can include final year students, along with an Intern/Junior Medical Officer/Registrar (JMO) (in particular RCS graduates), offering support for practice OSCEs during the year. These practice sessions are usually informal and organised within a small group setting. Topics for OSCEs are suggested by both Year 4 and Year 5 students. Assessment results are not collected and there is an emphasis on the formative nature of the OSCE practice. If requested, RCS academics are available to give advice on the construction of the cases. Students also provide support for one another in a variety of ways including such activities as inter‐professional skills learning at the Smithton emergency skills weekend. 8.2.2 Final Year Peer Support Program
Year 5 students are supported by NWRH interns (especially RCS graduates) and there are a number of common tutorials and discussion groups. On the wards, interns provide valuable support to Year 5 students. In particular, final year students find it extremely valuable to “shadow” the interns of the clinical unit to which they are attached. Interns, Skills Centre educators and RCS academics/other clinicians can provide opportunities for practice OSCEs and further skills practice. 8.2.3 Horizontal Integration
One of the strengths of the RCS program is the availability of other health professionals to assist with learning opportunities. Students may find themselves learning from, or alongside, people in other disciplines, a situation which mirrors, and best prepares them for, real life situations on the wards and in the community. The concept of teamwork to share the load and deliver the best outcomes for patients is integral to the learning and teach at RCS.
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8.3 Additional Educational Support
Educational support is provided by onsite academic staff, with some visiting staff from Tasmania or further afield. This is augmented by access to the resources of the North West Regional Hospital library, through the support of the staff of the clinical library in Hobart and through electronic access to medical information. Where appropriate, additional support will be provided through video and teleconference contact with academic staff in other regions of the state. The librarian at the Cradle Coast campus of UTAS, Louise Earwalker, is available for any students needing assistance with educational resources or difficulties. Students may be eligible for support from the RCS to attend relevant conferences and other educational events. Application to the Associate Head should be made well in advance of the event (appropriate forms available on MyLO). Students attending conferences and educational events with support from the RCS or in RCS time, are expected to provide a brief report on what they have gained from these experiences and will generally be required to make a brief presentation to their peers. Consideration for support will only be given to activities that do not conflict with the RCS teaching program. Students wishing to undertake research projects should discuss this with their mentor and Research Fellow, Dr Mark Reeves, before commencing any involvement. In special circumstances, presentation of a research project may substitute for a formative assessment task. Students should be aware that involvement in research projects may require a heavy time commitment that must not detract from the requirements of the MBBS curriculum. 8.4 Communications
It will be the student’s responsibility to inform wards of their contact number (eg mobile phone) so they can be contacted out of hours for deliveries, emergencies etc. Students without mobile phones should check with RCS office staff about alternative ways of accessing out of hours calls for key learning opportunities. Academic and administrative staff, regularly update students by use of the UTAS email system. Students should check their emails at least twice per day and should ensure that all communication in relation to their program of study is via their UTAS email account. Electronic display screens at the RCS should also be checked for any program changes. 8.5 Professional and Personal Support
8.5.1 RCS Staff
Professional and personal support for students is a priority for the Rural Clinical School. We have a small staff committed to the successful implementation of the Rural Clinical Program. All staff are available to assist with operational matters ranging from accommodation, transport and educational requirements including IT support within the broader rural health workplace. The Rural Clinical School aims to provide a safe learning and safe living environment for students. While every effort has been made to ensure students’ time is safe and secure, in the event of an emergency or personal crisis, support is available.
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8.5.2 Personal GP Services
Several local GPs have agreed to be available for students to make appointments and a list will be available from the administration staff.
8.5.3 Medical/Counselling Services
Students can contact Student Support Services at the Cradle Coast campus for psychological health issues. Telephone 03 6430 4949 or ext 4949 from any internal UTAS phone.
9. APPENDICES Assessment forms for:
• Guidelines for Writing Case Histories • Complex Rural Longitudinal Case History • Clinical Log Book example
9.1 Guidelines for Writing Case Histories and Sample Marking Sheets
Please refer to SoM Handbook for the following guidelines:
• Complex Therapeutics Long Case – page 88 • Emergency Medicine Long Case – page 90 • Maternal & Child Health Long Case – page 92 • Psychiatry Long Case – page 94
9.2 Complex Rural Longitudinal Case History Assessment Form
Complex Rural Longitudinal Case Assessment Form
Case Identification
Student name
Assessor/s
Date/GP Semester I or II
Performed Competently
Performed but not yet fully competent
Not performed competently
Not performed
A. DEMONSTRATES AN UNDERSTANDING OF THE UNDERLYING CLINICAL CONDITION/S AND MANAGEMENT ISSUES:
1. Demonstrates appropriate knowledge of the conditions.
2. Demonstrates appropriate knowledge of investigations/examinations pertinent to the case.
3. Adequately describes and discusses the management plan.
4. Describes the follow‐up process in which the student has engaged eg., home visits, attendance at community based specialists, hospital admission/visits and GP appointments.
5. Demonstrates an understanding of decision analyses and cost‐effectiveness analysis eg., medications, investigations.
B. DEMONSTRATES AN UNDERSTANDING OF ISSUES RELATING TO THE RURAL CONTEXT:
6. Socio‐demographic and cultural differences between rural and city life, and their effect on professional/patient/community relationships including aboriginal health care issues where appropriate.
7. Conduct of referrals, and the relationships between the referring rural GP and the city and/or provincial specialist.
8. Impact of isolation (personal and geographic) on patient and family behaviour in addressing health problems and medical management.
9. Inter‐relationship between rural and urban health care providers and facilities.
10. Knowledge of the social services in the community in which they are working.
C. DEMONSTRATES WELL DEVELOPED COMMUNICATION SKILLS:
11. Provides useful summary of current research and its impact on ideas about best practice re rural context and clinical management.
12. Uses communication tools effectively.
13. Engaged audience in effective and relevant discussion issues raised by the case.
Assessment Feedback:
ASSESSMENT RESULT:
____________________________ _________________________
Examiner’s Signature Please print name
_______________________________ ________________________ Position Date
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9.3 Clinical Log Book example
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9.4 Clinical Log Book example – Example of Satisfactorily completed Log Book
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